Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
J Arthroplasty. 2018 Apr;33(4):1166-1170. doi: 10.1016/j.arth.2017.11.040. Epub 2017 Nov 29.
As periprosthetic joint infections (PJIs) can have tremendous health and socioeconomic implications, recognizing patients at risk before surgery is of great importance. Therefore, we sought to determine the rate of and risk factors for deep PJI in patients undergoing primary total hip arthroplasty (THA).
Clinical characteristics of patients treated with primary THA between January 1999 and December 2013 were retrospectively reviewed. These included patient demographics, comorbidities (including the Charlson/Deyo comorbidity index), length of stay, primary diagnosis, total/allogeneic transfusion rate, and in-hospital complications, which were grouped into local and systemic (minor and major). We determined the overall deep PJI rate, as well as the rates for early-onset (occurring within 2 years after index surgery) and late-onset PJI (occurring more than 2 years after surgery). A Cox proportional hazards regression model was constructed to identify risk factors for developing deep PJI. Significance level was set at 0.05.
A deep PJI developed in 154 of 36,494 primary THAs (0.4%) during the study period. Early onset PJI was found in 122 patients (0.3%), whereas late PJI occurred in 32 patients (0.1%). Obesity, coronary artery disease, and pulmonary hypertension were identified as independent risk factors for deep PJI after primary THA.
The rate of deep PJIs of the hip is relatively low, with the majority occurring within 2 years after THA. If the optimization of modifiable risk factors before THA can reduce the rate of this complication remains unknown, but should be attempted as part of good practice.
由于假体周围关节感染（PJI）会对患者的健康和社会经济状况产生重大影响，因此，在手术前识别出有风险的患者非常重要。因此，我们旨在确定接受初次全髋关节置换术（THA）的患者中深部 PJI 的发生率和危险因素。
回顾性分析了 1999 年 1 月至 2013 年 12 月期间接受初次 THA 治疗的患者的临床特征。这些特征包括患者人口统计学资料、合并症（包括 Charlson/Deyo 合并症指数）、住院时间、主要诊断、总输血/同种异体输血率以及院内并发症，这些并发症分为局部和全身（轻度和重度）。我们确定了总体深部 PJI 发生率，以及早发性（发生在指数手术后 2 年内）和迟发性 PJI（发生在手术后 2 年以上）的发生率。构建 Cox 比例风险回归模型以确定发生深部 PJI 的危险因素。显著性水平设为 0.05。
在研究期间，36494 例初次 THA 中有 154 例（0.4%）发生深部 PJI。122 例（0.3%）发生早发性 PJI，32 例（0.1%）发生迟发性 PJI。肥胖、冠状动脉疾病和肺动脉高压是初次 THA 后发生深部 PJI 的独立危险因素。
髋关节深部 PJI 的发生率相对较低，大多数发生在 THA 后 2 年内。如果在 THA 前优化可改变的危险因素能否降低这种并发症的发生率尚不清楚，但应作为良好实践的一部分加以尝试。
